Healthcare Provider Details

I. General information

NPI: 1982151494
Provider Name (Legal Business Name): JASMINE RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SIERRA RD
CONCORD CA
94518
US

IV. Provider business mailing address

PO BOX 22210
OAKLAND CA
94623-2210
US

V. Phone/Fax

Practice location:
  • Phone: 925-363-1256
  • Fax: 925-356-2499
Mailing address:
  • Phone: 510-535-4000
  • Fax: 510-535-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number29307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: